The History of Bipolar Disorder

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Bipolar disorder is one of the most highly investigated
neurological disorders. The National
Institute of Mental Health (NIMH) estimates that it affects over 2 percent
of adults in the United States. Of these, nearly 83 percent have “severe” cases
of the disorder. Unfortunately, due to social stigma, funding issues, and a
lack of education, less than 40 percent receive what the NIMH calls “minimally
adequate treatment.”

The history of bipolar disorder is perhaps just as complex as the
condition itself. Bipolar is highly recognized as a treatable disorder. The
more we learn about bipolar disorder, the more people may be able to receive
the help that they need.

Ancient Beginnings

Aretaeus of Cappadocia began the process of detailing symptoms in
the medical field as early as the 1st Century in Greece. His notes
on the link between mania and depression went largely unnoticed for many
centuries.

The ancient Greeks and Romans were responsible for the terms
“mania” and “melancholia,” which are now the modern day manic and depressive.
They even discovered that using lithium salts in baths calmed manic people and
lifted the spirits of depressed people. Today, lithium is a common treatment
for bipolar patients.

The Greek philosopher Aristotle not only acknowledged melancholy
as a condition, but thanked it as the inspiration for the great artists of his
time.

It was common during this time for people across the globe to be executed
for having bipolar disorder and other mental conditions. As the study of
medicine advanced, strict religious dogma stated that these people were
possessed by demons and should therefore be put to death.

Bipolar Studies in the 17th Century

In the 17th Century, Robert Burton wrote the
book, The Anatomy of Melancholy, which addressed the issue of
treating melancholy (non-specific depression) using music and dance as a form
of treatment. While mixed with medical knowledge, the book primarily serves as
a literary collection of commentary on depression, and a vantage point of the
full effects of depression on society. It did, however, expand deeply into the
symptoms and treatments of what is now known as clinical depression.

Later that century, Theophilus Bonet published a great work
titled Sepuchretum, a text that drew from his experience performing
3,000 autopsies. In it, he linked mania and melancholy in a condition called
“manico-melancolicus.”

This was a substantial step in diagnosing the disorder because
mania and depression were most often considered separate disorders.

19th and 20th Century Discoveries

Centuries passed and little new was discovered about bipolar
disorder until French psychiatrist Jean-Pierre Falret published an article in
1851 describing what he called “la folie circulaire,” which translates to
circular insanity. The article details people switching through severe
depression and manic excitement, and is considered to be the first documented
diagnosis of bipolar disorder.

In addition to making the first diagnosis, Falret also noted the
genetic connection in bipolar disorder, something medical professionals still
believe to this day.

The history of bipolar disorder changed with Emil Kraepelin, a
German psychiatrist who broke away from Sigmund Freud’s theory that society and
the suppression of desires played a large role in mental illness. Kraepelin
recognized biological causes of mental illnesses. He is believed to be the first
person to seriously study mental illnesses.

Kraepelin’s Manic Depressive Insanity and Paranoia in
1921 detailed the difference between manic-depressive and praecox, which is now
known as schizophrenia. His classification of mental disorders remains the
basis used by professional associations today.

A professional classification system for mental disorders — which
was important to better understand and treat conditions — has its earliest
roots in the early 1950s from German psychiatrist Karl Leonhard and others.

The term “bipolar” — which means “two poles” signifying the polar
opposites of mania and depression—first appeared in the American
Psychiatric Association’s (AMA) Diagnostic and Statistical Manual of
Mental Disorders (DSM) in its third revision in 1980.

It was that revision that did away with the term mania to avoid
calling patients “maniacs.” Now in it’s fifth version, the DSM is considered
the leading manual for mental health professionals.

Modern Criteria

The current version (DSM-5) lists the following subtypes of
bipolar disorder with the following diagnostic criteria:

Bipolar I Disorder

at least one manic episode and one or more major
depression episode

equally common in men and women, with the first
episode in men usually being mania, and the first episode in women typically
being major depression.

Bipolar II Disorder

major depression

instead of full-on mania, they experience
hypomania: high energy, impulsiveness, and excitability, but less severe as
full-fledged mania.

more common in women than men

Cyclothymic Disorder

less severe mood swings

episodes shifting from hypomania to mild
depression

rapid changes in mood — with four or more
episodes of major depression, mania, hypomania, or mixed symptoms within a
year.

may have more than one episode in a week or even
within one day

more common in people who have their first
episode at a younger age

affects more women than men

Rapid-Cycling Bipolar Disorder

Rapid-cycling bipolar disorder includes the same fluctuations
manic and depressive symptoms. The difference is that the cycles are shorter,
so people experience shorter, more frequent bursts of manic and depressive
posts. This is considered the most severe form of bipolar disorder.

The Future of Diagnosis and Treatment

Our understanding of bipolar disorder has certainly evolved since
ancient times. Fortunately, great advances in education and treatment have also
come a long way in just the past century alone. Still, there is a lot of work
to be done because many people aren’t getting the treatment they need to lead
better quality lives.

While bipolar disorder typically shows up in a person’s 20s, it
can appear during any stage of life. It’s important to identify the symptoms so
you can help yourself or a loved one who might have the condition. The earlier
a person receives a diagnosis, the more effective a treatment plan may be.
Long-term solutions often involve a combination of medications and counseling.